Feb 23, 2018

Interview Transcript

Interviewer: Will personalized medicine improve population health? We'll talk about that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: On March 16th, University of Utah Health will be co-sponsoring the annual Frontiers in Precision Medicine Symposium. Dr. Bress, you're an organizer for the conference. If you were to try to convince someone to attend, what would you tell them?

Dr. Bress: When you think about health in the United States, both from a clinical medicine and public or population health perspective, we are doing poorly. Healthcare costs in the United States are rising roughly two times the rate of inflation, which is unsustainable. And despite spending two times more per capita than the wealthiest countries across the world, we are near the bottom in terms of health metrics such as life expectancy or infant mortality.

And the reason to come to this year's Frontiers in Precision Medicine 3 Symposium is to participate in a discussion with international leaders in the fields of personalized medicine, genomics, epidemiology, health disparities, regulatory science, and bioethics on how personalized medicine can improve population health, reduce health disparities, increase high-value interventions, and overall, improve population health.

Interviewer: And I think for maybe the uninitiated who've maybe heard some of these terms but aren't quite sure what they mean, can you define some of them?

Dr. Bress: Precision medicine is the idea that each individual's unique genetic profile, social environment, and lifestyle can be used to better determine the optimal approach to prevent, diagnose, and treat disease for that individual. An example would be lowering the dose of a medication you are taking based on the result of a DNA test that revealed you have a genetic marker that reduces the metabolism of that drug in your body.

Interviewer: And then what's population health?

Dr. Bress: So the definition of population health is debated and evolving. That said, the classic definition of population health is the overall health of a group of individuals which includes the distribution of those health outcomes within the group. And these populations are often geographic regions such as the United States or the Salt Lake Valley. But they can also be other groups such as employee groups, ethnic groups, disabled persons, or veterans. And population health is often focused on the Triple Aim: improving the individual experience of health care from the patient's perspective; two, reducing per capita cost of health care. And three, improving the health of individuals and populations.

Interviewer: I mean, how can you have both at the same time? Or can you? Is there a conflict between these two?

Dr. Bress: One way to look at it is that a population is made up of a collection of individuals. So I don't necessarily think they are at odds with each other. Each are attacking the problem from different angles. An important topic of conversation that will be a key focus of the symposium is, how do we balance public and private investment in funding research and interventions at the population level and at the individual level?

Interviewer: Is there any certain aspect or a person who's going to be presenting at this symposium that you're particularly excited about?

Dr. Bress: I mean, of course I'm excited for them all. But in particular, I'm excited to hear from Dr. Muin Khoury, who is the director, the founding director, of the Office of Public Health Genomics at the CDC. And I'm excited to hear his vision of what he calls precision public health. And he argues that the same technologies that propel personalized medicine such as genetics and big data could usher in a parallel era of what he calls precision public health.

So he argues that if precision medicine is about providing the right treatment for the right patient at the right time, precision public health providing the right intervention to the right population at the right time. So, for an example, an effective smoking cessation program may work differently in Oakland than it would in Atlanta due to infrastructure or socio-cultural differences between the populations.

So he'll tell us his vision on building more accurate methods for measuring disease pathogens, exposures, behaviors, and susceptibilities which could allow for better assessment of population health and development of precision and targeted policies for programs to prevent disease that are tailored to each population and community's unique characteristics.

Interviewer: So is there anything else that you'd like to let us know about?

Dr. Bress: So I'd like to talk about three controversies that the precision medicine symposium will touch on that I think are particularly exciting. First, as with all new technologies, genomics and some personalized medicine technologies have the potential for widening the divide between the haves and the have-nots in the U.S. So this will be a major focus. We have a special panel on personalized medicine, population health, and health disparities.

Second, will investments in precision medicine take away resources from population-based interventions that we know work in most, such as programs to reduce smoking, poverty, and obesity? We know that federal funding for research grants with a population health or public health goal have declined in the last 10 years whereas funding for research for genomic applications has increased.

Third, some will argue that the solution to these challenges in health in the United States is probably not an increased focus on the individual in terms of solutions but rather involves focusing on the social, economic and structural determinants of population health that are ubiquitous and deeply and inevitably linked to health as a country.

Interviewer: One thing that I think is really great about this symposium is that it's not just your standard 30-minute talk, questions, and answers but there's a panel discussion for each of these topics. And I think that's going to be a really great way for people to talk and really hash out some of these issues.

Dr. Bress: We will have several sessions with panel discussions. So I think it's going to be a really exciting discussion and really focused on these, whether they're real or perceived, tensions between how do we move health forward in the United States given the recent explosion of genomic technologies and a focus on precision medicine.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

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